Effects of low-level laser therapy and eccentric exercises in the treatment of recreational athletes with chronic achilles tendinopathy
Low-level laser therapy, with the parameters used in this study, accelerates clinical recovery from chronic Achilles tendinopathy when added to an EE regimen. For the LLLT group, the results at 4 weeks were similar to the placebo LLLT group results after 12 weeks.
In part 1 of this article, the author discussed the technical profile of class IV laser therapy and introduced ideas for incorporating this technology into the chiropractic clinic. In part 2, clinical applications for class IV laser therapy will be discussed along with their proposed mechanisms of action. Two case studies will be presented.
Over the past 20 years, technology has had a profound impact on the chiropractic profession. Among emerging technologies, therapeutic lasers are increasingly taking a more prominent position in treatment of chronic back and neck pain, sports injuries, and musculoskeletal conditions. Therapeutic lasers have had a dramatic impact on chiropractors’ ability to target and accelerate healing of injured soft tissue, resulting in noteworthy outcomes. They have a place in just about every clinic. In fact, chiropractors are also seeing greater numbers of informed patients who are actively seeking laser therapy treatment for their pain.
With so many different lasers available, it can be confusing to figure out which one is right for your chiropractic clinic. But the therapeutic features and benefits of Class IV lasers are so significant that a growing number of doctors are considering including them in their arsenal of therapeutic treatment tools.
Compared to Class IIIa and Class IIIb therapy lasers, Class IV therapy lasers deliver more energy per unit of time, and therefore can deliver therapeutic dosages of laser light to a larger volume of tissue in a shorter period of time. Class IV lasers are most successful in treating chronic and deeper-seated soft-tissue problems. Class IV lasers also successfully enable regeneration and help to fight infection.
Deeper healing and pain relief is best achieved using Class IV lasers.
This case report is presented to offer a potential intervention strategy in the treatment of resistant chronic back and leg pain with multifactorial central and foraminal stenosis.
The use of low levels of visible or near infrared light for reducing pain, inflammation and edema, promoting healing of wounds, deeper tissues and nerves, and preventing tissue damage has been known for almost forty years since the invention of lasers. Originally thought to be a peculiar property of laser light (soft or cold lasers), the subject has now broadened to include photobiomodulation and photobiostimulation using non-coherent light. Despite many reports of positive findings from experiments conducted in vitro, in animal models and in randomized controlled clinical trials, LLLT remains controversial. This likely is due to two main reasons; firstly the biochemical mechanisms underlying the positive effects are incompletely understood, and secondly the complexity of rationally choosing amongst a large number of illumination parameters such as wavelength, fluence, power density, pulse structure and treatment timing has led to the publication of a number of negative studies as well as many positive ones. In particular a biphasic dose response has been frequently observed where low levels of light have a much better effect than higher levels.
Myofascial Pain Syndrome is among the leading diagnoses of pain management specialists and is certainly a common complaint among patients seeking chiropractic care.
The role of myofascial trigger points (MTrPs) in myofascial pain syndrome (MPS) is noticed every day in musculoskeletal clinical practice since first 952. identified by Travell and Rinzler in 1952.
The laser was theorized by Einstein in 1917 and invented by Maiman in 1960. Its unique property of light waves being coherent in space and in time led many to theorize that it could be a damaging form of electromagnetic radiation. Dr. Endre Mester conducted experiments on mice afflicted with skin cancer in 1967 and found that shaved areas grew hair more rapidly when exposed to low levels of laser light.
Thus the field of laser therapy was born and now, 42 years later, therapeutic lasers are gaining acceptance in the chiropractic profession for the treatment of chronic pain, sports injuries, musculoskeletal conditions and more. While exhibiting at a chiropractic trade show a couple years ago, a wily old doctor asked me, “How do you know you’re not causing cancer?” which is an excellent question. Let’s talk about laser and its effects on tissue.
LLLT administered with optimal doses of 904 nm and possibly 632 nm wavelengths directly to the lateral elbow tendon insertions, seem to offer short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen. This finding contradicts the conclusions of previous reviews which failed to assess treatment procedures, wavelengths and optimal doses.
In this review, seven studies using photoradiation to treat carpal tunnel syndrome (CTS) are discussed: two controlled studies that observed real laser to have a better effect than sham laser, to treat CTS; three openprotocol studies that observed real laser to have a beneficial effect to treat CTS; and two studies that did not observe real laser to have a better effect than a control condition, to treat CTS.
Although low energy laser therapy had no advantage compared to placebo in patients with LE for the short term, a significant improvement, particularly in functional parameters, was achieved in the long term. Laser, which has relatively no side effects, might be included among long-term treatment options for LE.
Reported results show that superpulsed laser irradiation, like the continuous and pulsed counterparts, possesses osteogenic properties, inducing the expression of molecules known to be important mediators of bone formation and, as a consequence, increasing calcium deposits in human MG-63 cells. Moreover, the data suggest a new potential role for PPARgamma as a regulator of osteoblast proliferation.
Low-level laser therapy (LLLT) is thought to have an analgesic effect as well as a biomodulatory effect on microcirculation. This study was designed to examine the pain-relieving effect of LLLT and possible microcirculatory changes measured by thermography in patients with knee osteoarthritis (KOA).
Laser therapy has been reported as an important tool to positively stimulate bone both in vivo and in vitro. These results indicate that photophysical and photochemical properties of some wavelengths are primarily responsible for the tissue responses. The use of correct and appropriate parameters has been shown to be effective in the promotion of a positive biomodulative effect in healing bone.
Diabetic foot problems due to angiopathy and neuropathy account for 50% of all nontraumatic amputations and constitute a significant economic burden to society. Low-intensity laser irradiation has been shown to induce wound healing in conditions of reduced microcirculation. We investigated the influence of low-intensity laser irradiation by means of infrared thermography on skin blood circulation in diabetic patients with diabetic microangiopathy.
The data from this first randomized double-blind placebo-controlled clinical trial demonstrate an increase in skin microcirculation due to athermic laser irradiation in patients with diabetic microangiopathy.
The purpose of this study was to evaluate the influence of monochromatic infrared energy (MIRE) on the microcirculation of the skin surface of the feet in healthy subjects.
Laser therapy at the 3-W (360-J) dose level was an effective treatment modality to increase blood flow in the soft tissues.
Objective: This case report is presented to offer a potential intervention strategy in the treatment of resistant chronic back and leg pain with multifactorial central and foraminal stenosis.
Conclusion: Class IV laser therapy may be a treatment option in patients with chronic multifactorial low-back pain, possibly allowing for earlier active intervention and return to ADLs. Natural history influence on improvement cannot be excluded as a contributory factor in symptom reduction in this case study. Since laser therapy was initiated 9 months post-injury with ongoing symptoms, the amount of contribution is uncertain. More controlled studies with high-power laser therapy and significantly greater total doses than are possible with Class II and III lasers are necessary for a broader understanding of this emerging modality.